CONTINUITY OF CARE BY A MIDWIFE TEAM VERSUS ROUTINE CARE DURING PREGNANCY AND BIRTH - A RANDOMIZED TRIAL

Objective: To compare continuity of care from a midwife team with rout ine care from a variety of doctors and midwives. Design: A stratified, randomised controlled trial. Participants and setting: 814 women atte nding the antenatal clinic of a tertiary referral, university hospital . Intervention: Women were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwiv es. Main outcome measures: Antenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment. Results: 405 women were randomly allocated to team care and 409 to routine care; they deliver ed 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% CI, 1.23-2.42); less likely to use pethidine during labour (OR, 0.32; 95% CI, 0.22-0.46); and mor e likely to labour and deliver without intervention (OR, 1.73; 95% CI, 1.28-2.34). Babies of team care mothers received less neonatal resusc itation (OR, 0.59; 95% CI, 0.41-0.86), although there was no differenc e in Apgar scores at five minutes (OR, 0.86; 95% CI, 0.29-2.57). The s tillbirth and neonatal death rate was the same for both groups of moth ers with a singleton pregnancy (three deaths), but there were three de aths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine ca re for all measures of maternal satisfaction. Team care meant a cost r eduction of 4.5%. Conclusion: Continuity of care provided by a small t eam of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcom es. Although a much larger study would be required to provide adequate power to detect rare outcomes, out study found that continuity of car e by a midwife team was as safe as routing care.